Cost and impoverishment 1 year after hospitalisation due to injuries: a cohort study in Thái Bình, Vietnam Ha Nguyen, 1 Rebecca Ivers, 2 Stephen Jan, 2 Alexandra Martiniuk, 2 Leonie Segal, 1 Cuong Pham 3 1 School of Population Health, University of South Australia, Adelaide, South Australia, Australia 2 The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia 3 The Center for Injury Policy and Prevention Research, Hanoi School of Public Health, Hanoi, Vietnam Correspondence to Ha Nguyen, School of Population Health, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA 5000, Australia; ha.nguyen2@unisa.edu.au Received 1 December 2014 Revised 5 May 2015 Accepted 23 May 2015 To cite: Nguyen H, Ivers R, Jan S, et al. Inj Prev Published Online First: [ please include Day Month Year] doi:10.1136/ injuryprev-2014-041493 ABSTRACT Background Evidence on the economic impact on individuals and their families following an injury in Vietnam is limited. This study examines the costs and the risk of impoverishment due to hospitalised injuries at 12 months following hospital discharge and associated factors. Method Employing a prospective cohort design, 892 people hospitalised for injury were recruited from Thái Bình General Hospital in Vietnam in 2010 and followed up for 12 months. All out-of-pocket costs incurred and income lost by injured persons and their caregivers associated with care and treatment of their injuries were reported. To examine associated factors, we used generalised estimating equation models for costs and modified Poisson regression for the risk of impoverishment. Results The mean total costs by 12 months postdischarge were US$804, nearly 1.2 times the annual average income. Injuries that incurred highest costs were falls (US$950) and road traffic injuries (RTIs) (US$794). At 12-month follow-up, 181 persons (26.9%) became impoverished, with those injured in RTIs and falls at highest risk (26.1% and 35.4%, respectively). Factors associated with higher costs were also those associated with higher risk of impoverishment. These include those injured in RTIs or falls; having higher severity level; principal injured region as upper extremities, lower extremities or head; physical nature of injuries as fracture or concussion injuries; and longer hospitalisation. Conclusions Injuries impose significant economic burden on injured persons and their families during and beyond hospitalisation. In addition to prevention, there is a need to reform health financing system to protect injured persons from significant out-of-pocket expense for healthcare services. INTRODUCTION Accounting for 10% of the world’s deaths, injuries rank one of the leading causes of death in all regions and countries. Globally, there are 32% more deaths from injuries than deaths from malaria, tuberculosis and HIV/AIDS combined. 1 2 Although injuries affect people of all ages and income groups, more than 90% of injury deaths are in low and middle income countries (LMICs). 12 According to the most recent statistics on injuries in Vietnam, in 2010, there were more than 39 000 injury deaths, accounting for 11.6% of all mortality and a rate of 43.8/100 000 persons. 3 The 10 leading causes of death also include three specific injuries: road traffic injuries (RTIs), drowning and suicide. 3 In addition to fatality, injuries lead to mil- lions of non-fatal cases. As reported in the Vietnam National Survey on Injury 2010, an estimated 1.8 million (2092/100 000 persons) were non-fatal injuries. Of these, 36% or 648 000 cases were hospitalised for at least 1 day. 4 The large burden of injuries creates significant cost to the national economy, including loss of productivity, costs for treatment and rehabilitation, plus other costs such as administration and prop- erty damages. In the USA, Corso et al 5 reported in 2006 that for more than 50 million injuries in 2000, the associated lifetime costs were US$406 billion, including US$80 billion for medical treat- ment and US$326 billion for lost productivity. In Europe, Meerding et al 6 reported the lifetime costs for medical treatment for injuries on a cohort of 5755 patients were €1.15 billion, accounting for an estimated 3.7% of total national healthcare expend- iture. In Australia, with an estimated 8000 injury deaths (6% of all deaths) and an estimated 400 000 injury hospitalisations each year, the health costs associated with injury in 2004–2005 were esti- mated at $A3.4 billion, accounting for 7% of national allocated health expenditure. 7 In China, the world’s most populous country, the annual cost of injury was estimated at US$12.5 billion, almost four times the national public health services budget. 8 In a review of 68 studies conducted in 22 LMICs, the median of combined direct and indirect costs of injuries was US$4085 or 97% of gross domestic product per capita. 9 Injuries can also lead to significant financial hard- ship to the injured and their families, particularly in countries where out-of-pocket payment for healthcare service is common. However, evidence on this issue is scarce in Vietnam. Based on 35 trau- matic brain injuries due to motorcycle incidents, Hoang et al 10 reported the total direct costs at US $2365, US$1390 and US$849 for severe, moderate and minor cases, respectively; 84% of households experienced catastrophic expenditure because of the treatment costs after 1 year. From a sample of 892 hospitalised injuries, Nguyen et al estimated the average direct costs during hospitalisation were US$317.2. At discharge, 27% of samples faced catastrophic expenditure. 11 While these studies pro- vided important evidence of the economic burden of injuries, they are either limited in small sample or short study period. Continuing care and treat- ment required beyond hospitalisation result in further costs, which could push the injured and their families into poverty. In a study of injuries in 1999–2001 in Vietnam, Thanh et al 12 found that the risk of impoverishment of household with injury was 1.21 times (p=0.08) the risk of those without injuries. To better understand the longer term economic impact of injuries, our study esti- mates the costs by 1 year after hospital discharge Nguyen H, et al. Inj Prev 2015;0:1–7. doi:10.1136/injuryprev-2014-041493 1 Original article IP Online First, published on June 12, 2015 as 10.1136/injuryprev-2014-041493 Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on June 12, 2015 - Published by http://injuryprevention.bmj.com/ Downloaded from